Beljay Performance Horses Chilled Semen Request Form 2023

Beljay Performance Horses Chilled Semen Request Form 2023
Forms must be completed by 4pm EST – the day prior to collection day.
• Please confirm completed order by text to 0488 777 660
• All chilled semen requests must have prior approval by the Stallion Owner and signed Contracts
Date of Semen Order

MonthDayYear
Date
Delivery date required

MonthDayYear
Date
Stallion required
Mare being bred
Delivery Type

Toll OvernightQantas Freight
Mare Owners Name

First NameLast Name
Postal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Home Phone
Please enter a valid phone number.
Mobile
Please enter a valid phone number.
Semen Shipment Delivery Address

(excess freight charges may apply if not airport to airport)
Name

First NameLast Name
Mobile Number - of person receiving the package
Please enter a valid phone number.
Home Phone Number - of person receiving the package
Please enter a valid phone number.
Delivery Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Collection Cost: $395 inc GST plus freight cost below. Toll priority Overnight

QLD - $120NSW - $145VIC - $165WA - $190Qantas Freight– Quote required. For all Quantas freight shipments, contact Belinda to arrange payment over the phone.
Toll Time Sensitive Freight - Add $110

YesNo
Payment Method

I will phone to arrange paymentBank Transfer
Bank Account Details
Name: Beljay Performance Horses
National Australia Bank
BSB: 084901
Account: 760317027
Semen shipper charge $35 if esky not returned to Beljay Performance Horses within 14 days.

Semen is always assessed at time of collection and all care and diligence is taken prior to dispatch to freight company. However, Beljay Performance Horses will not be held liable for any costs/damages incurred by the mare owner or any third party that are associated with lost, delayed or damaged semen or unavailability of chilled semen. Beljay Performance Horses does not offer any warranty as to the fertility of any stallion standing at or available at Beljay Performance Horses. Mare owner indemnifies Beljay Performance Horses from and against any such claim/s. By signing and/or completing dorm on behalf of mare owner, third party is authorized to do so by mare owner.
Name

First NameLast Name
Signature of mare owner or authorized Agent

Clear
Date

MonthDayYear
Date
Should be Empty:

Beljay Performance Horses Chilled Semen Request Form 2023

Semen Shipment Delivery Address